Informaticopia

Saturday, July 28, 2007

INTERNET ACCESS - IS THE EXPENSE JUSTIFIABLE?

CHILD2015 SUMMARY. INTERNET ACCESS - IS THE EXPENSE JUSTIFIABLE?

Introductory note from CHILD2015 co-moderator (Neil PW):

Please find below a summary/extracts from our recent discussion on thesubject of ‘Internet access: is the expense justifiable?’. A formattedversion is publicly available on the Resources section of the HIFA2015 webarchive: www.dgroups.org/groups/hifa2015

The discussion was held simultaneously on our two ‘sister’ groups:HIFA2015 and CHILD2015, between 4th and 10th July 2007. There were twentyfour messages: eight from USA, seven from UK, three from India and oneeach from Gambia, Colombo, Kenya, Canada, Uganda and South Africa. Namesof the 21 contributors are listed below.

As with all CHILD2015 Summaries, this is a ‘living summary’ that will beregularly updated. Further contributions on this topic are welcome -please send to hifa2015@dgroups.org

Our thanks to CHILD2015 volunteer Zaynab Lambat for preparing this summary(CHILD2015 profile: Zaynab Lambat is a pharmacist by profession, and hasworked extensively in Africa, and as a Trainer and Consultant in Holland.Her main interest is promoting health in developing countries. She iscurrently based at the University of Swansea, UK, where she is working onlearning modules for International Health. feroz.gaibie AT virgin.net)

SUMMARYThis discussion was prompted by a message from Stephen Allen, a CHILD2015co-moderator and adviser for the CHILD2015 email discussion group. He hadjust attended a workshop called ‘Wales for Africa’ in Cardiff, Wales (UK).

The workshop emphasised the importance of internet access for Africanpartners. It was proposed that this was essential for good communicationbetween the partners and also for access to healthcare information.

However, a participant from Africa emphasised the many difficulties andcost of establishing and maintaining internet access. His view was thatinternet access was a luxury that could not be justified where healthinstitutions were short of essential drugs, equipment and staff.

Stephen Allen asked: "How can the right balance be struck between, on theone hand, allocating scarce resources to ensuring adequate supplies ofdrugs, staff etc. and, on the other, allocating resources to theinformation and training required to ensure that what is available is putto best use? Is the internet a crucial element in this - so that we shouldadvocate that all health institutions of a certain size must have internetaccess?"

CHALLENGESA member summed up the challenges as follows: "For most of us intechnologically advanced countries, purchasing Internet connectivity is ano-brainer. We capitalize on generations of technological, civic, andeconomic achievements and rarely think about the giants whose shoulders westand upon to enjoy round-the-clock power, reliable companies, trustworthypayment methods, more-or-less predictable legal environments, and armiesof trained technicians who set up and maintain our networks. But ourcolleagues in developing countries have a long way to go before they canspend an insignificant portion of their organization's budget to haveample, reliable Internet connections.

Even where internet is accessible, the content may be of limited value:"At least in some countries language is a barrier. English is the languageof science and medicine but it is not managed proficiently by ourprofessionals and students."

INTERNET CAN MAKE ALL THE DIFFERENCEAnother member commented: "The internet has changed how we work indevelopment and public health. We have a number of internet-based coachingprograms that allow us to coach participants to improve how they work andprovide services in developing countries. We have found out that if peopleare motivated and get valuable information and support, they do not mindwalking to the nearest cybercafй to visit our website, or get our emailswith the program materials and to send us their assignments once a day. Wealso use skype to chat or talk with program participants and our defaultrate is very low, and not due to the internet, but because they got busyat work or had some other personal problem and they defer their enrollmentto the next period. I believe the internet is great and changing the waywe provide assistance to health workers in developing countries. Theylearn to trust themselves and implement changes in their own terms andaccording to theirstrengths and talents! I think that with imagination, innovation andcreativity, we can take advantage of the connectivity the internet offers,and accelerate reaching the MDGs."

An example of the indispensability of the internet was given by anothermember: "internet access is so important: In 1998, a World Survey wasinitiated, using a secure Oracle database and submission of anonymous datavia the internet....The survey has now become the World Rb Registry, withprospective data... Internet access allows real-time consultation betweenmedics in resource-rich and resource-limited countries...."

THE EXPENSE OF INTERNET IS NOT ALWAYS JUSTIFIABLEOne member commented: "The answer must come from those who are using ortrying to use the internet."

Another: "There is an important difference between researchers andspecialists who cannot thrive without broadband and the average healthprofessional in poor countries - not every healthworker needs - or hastime - to trawl the web for appropriate medical information....Howwasteful of human resources if every practitioner, every clinician (Northor South) had to check the Web to keep up with best practice and mosteffective and efficient therapies. Should it not be the responsibility ofthe country's or region's central health authority or medical school -and/or of the WHO national or regional office - to distribute suchinformation - centrally gathered and synthesized from Internet or othercurrent sources - to all health workers for whom it is relevant?" Theauthor gave examples of the Zimbabwe quarterly digest CHIZ - CurrentHealth Information Zimbabwe and the CME Uganda newsletter that isdistributed by email.

Another CHILD2015 member commented that internet connectivity is the mostcost-effective source of knowledge for some situations. Not every facilitycould have it but tertiary centres should not go without it. The amount ofmoney need to buy every new edition of a text book will certainly be morethan that needed to maintain an internet line. Patients in developingcountries need the best care with the right skills and knowledge just likeanywhere in the world.

SOLUTIONS

1. MAKE THE INTERNET MORE ACCESSIBLE AND AFFORDABLE"Once wireless internet access becomes available (thus obviating the needfor land lines), I am hopeful that more medical institutions world-widewill gain access to this valuable resource."

"Open access principles where applicable should be applied."

2. PROMOTE INTERNET ACCESS WHERE IT IS MOST NEEDED"While many individuals do not have access to the internet, most trainingfacilities do. By making paper-based self-help learning courses availableon free websites, training facilities can access the material and thenprint their own education manuals for local use. This is an easy, cheapand effective way of enabling local, regional or national healthcareauthorities to get a wide range of appropriate learning material to allprofessional health care workers in their service. For the past 12 yearswe have used this method of empowering groups to very successfully managetheir own continuing education and professional growth without the need offormal trainers and online internet access.

3. USE ALTERNATIVE METHODS"Are there other, better, less expensive ways to get information intopeople's hands?... If computers are to be used, what kinds of informationcan we deliver without Internet bandwidth? What kinds of information canONLY be delivered via the Internet? These are worthwhile distinctions tomake as we construct information dissemination strategies that meet theneeds of the varied practitioners in the field. In March I visited themedical school in Liberia. A student there related how he had parked hiscar next to a hotel that had wireless Internet. He "poached" somebandwidth and downloaded a physiology textbook over the course of a couplehours. He then copied this textbook to a flash drive and shared it withhis classmates. After a couple of months, everyone in his (small) classhad read or copied the book from the flash drive. We can capitalize onthese kinds of innovative knowledge sharing activites."

"Mobile phones may be a more useful medium."

"I think it's important that we continue to look for more cost effectiveways to deliver knowledge... The eGranary Digital Library is one (seehttp://www.egranary.org) but there are others (like simple CD-ROMs andflash drives.)"

"Freedom Toasters are conveniently located, self-contained,computer-based, 'Bring 'n Burn' facilities. Like vending machines,preloaded to dispense confectionery, Freedom Toasters are preloaded todispense free digital products, including software, photography, music andliterature. The Freedom Toaster project began as a means of overcoming thedifficulty in obtaining Linux and Open Source software due to therestrictive telecommunications environment in South Africa." (Source ofpreceding text: http://www.freedomtoaster.org). These "kiosks" cansubstantially bring down the costs of connectivity if (a) they can then becombined with some kind of delay tolerant networking systems to join witheach other (network of kiosks, the wider the better and we totally bypassthe conventional internet connectivity at no cost beyond the cost of onetime set up), and (b) key personnel in hospitals and small communities betaught how to do wireless networking in their own homes and communities."

CONTRIBUTORSPatricia Abbott is the Co-Director of the PAHO/WHO Collaborating Centrefor Nursing Knowledge, Information Management and Sharing at the JohnsHopkins School of Nursing in Baltimore, USA. She is also a member of theBoard of Directors for the American Medical Informatics Association (AMIA)and serves on the Editorial Board of the Journal of the American MedicalInformatics Association (JAMIA). Patricia is a Fellow of the AmericanCollege of Medical Informatics and the American Academy of Nursing. DrAbbott’s primary area of research is in connectionist machine learningtechniques/data mining. Additionally, Dr. Abbott serves as theSecretariat for the Global Alliance of Nurses and Midwives Communities ofPractice effort; a WHO initiative to address the crisis in the globalhealth workforce. pabbott2 AT son.jhmi.edu

Stephen Allen is a co-moderator and adviser for the CHILD2015 emaildiscussion group. He is a Reader in Paediatrics and Honorary ConsultantPaediatrician at the School of Medicine, Swansea University, UK. He is theOverseas Director for Africa for the David Baum International Foundation,and a committee member of the International Child Health Group, inassociation with the Royal College of Paediatrics and Child Health, UK. Hehas 4 years experience in Papua New Guinea and 6 years with the MedicalResearch Council, The Gambia, involved in training, research and clinicalpaediatrics. He has developed eLearning in international health inpartnership with colleagues at the University College Hospital, Ibadan,Nigeria (seehttp://www.medicine.swan.ac.uk/inthealth.html). s.j.allen AT swansea.ac.uk

Ike Anya is a lecturer in public health at University College London.ike.anya AT gmail.com

Arindam Basu is a Consultant in Ear Nose and Throat Diseases andEpidemiologist, at the Guru Tegh Bahadur Medical Center in Kolkata, India.He is also currently working as the Associate Director of the FogartyInternational Training Program of the University of California atBerkeley. He is keenly interested in evidence based medicine,meta-analysis and systematic reviews. He works as an author of theClinical Evidence topic, "Earache in air travelers" for the secondaryevidence journal, "Clinical Evidence". His current area of interest is tocreate a web service in Ruby on Rails to enable healthcare researchers toquickly collect and appraise best evidence. He has been a member of theevidence based health discussion group since 1996. arin.basu AT gmail.com

Elvira Beracochea is a medical doctor and President and CEO of MIDEGO,Inc, based in Fairfax, USA. MIDEGO is a global health care consulting firmwhose mission is to help partners to reach the Millennium DevelopmentGoals. MIDEGO offers health care management consulting, capacity buildingand coaching services for health professionals and managers that want toachieve outstanding performance consistently and efficiently.www.midego.com elvira AT midego.com

Anuradha Bose is a paediatrician working in the departments of CommunityHealth and Child Health, Christian Medical College, Vellore. She hasinterests in Infectious Diseases and in Injury Prevention. The Departmentof Community Health is primarily committed to demonstrating the role of amedical college towards achieving health for all in Vellore districtthrough a participatory approach that empowers the people. Her interest isin issues related to child survival in India. Anu's department has avaried teaching programme, including teaching courses on InternationalHealth. abose AT cmcvellore.ac.in

Daisy Dharmaraj is a medical doctor specialised in Public Health, fromChristian Medical College, Vellore, India. She heads the AIDS desk of theNational Lutheran Health and medical board and TEST (Techno economicstudies and training) foundation in India. Both organisations are involvedin Primary Healthcare, health related action research and advocacy, andgender issues. Presently her focus is on HIV/AIDS prevention, care andsupport especially in the rural areas, and her primary concern is to makehealth care accessible to them.www.aidsindia.inwww.peopleshealthfoundation.org daisy.dharmaraj AT gmail.com

Matthew Ellis is a consultant paediatrician at Southmead Hospital,Bristol, UK. He is also a Senior Clinical Lecturer Child Health, Centrefor Child and Adolescent Health, Bristol University. His researchinterests include the public health of birth asphyxia in low incomecountries and the epidemiology of neurodevelopmental disorders ofchildhood. He is course director of the International Health BSc formedical students at Bristol University and convenor of the InternationalChild Health Group of the Royal College of Paediatrics and ChildHealth.m.ellis AT bristol.ac.uk

Cynthia Flynn is Associate Professor of Nursing at Seattle University,USA, and President-elect of the American Association of Birth Centers. Sheis interested in training midwives throughout the world. FlynnCNM ATaol.com

Abubacarr Jagne is a junior doctor at the Royal Victoria TeachingHospital, Banjul, The Gambia. abubacarrjagne AT gmail.com

Saroj Jayasinghe is Consultant Physician at the National Hospital inColombo and Associate Professor at the Dept of Clinical Medicine at theUniversity of Colombo. He is also Coordinator of the Postgraduate Diplomain Health Development and was the first Director of the Medical EducationDevelopment and Research Centre. His current research focuses on the areasof poverty, health determinants and health policy. sarojoffice ATyahoo.com

Jorge Maldonado is a senior physician, former Full Professor of Medicineat the Mayo Clinic, from Colombia with an interest in health information.He works on Saludhoy.com and Iladiba.com and cursosiladiba.com websites,which deliver health information to health professionals and the generalpublic in alliance with Colombia's National Academy of Medicine andNational Institute of Health. jorgem AT emsa.com.co

Clifford Missen is director of the WiderNet Project, a non-profitorganization at the University of Iowa, USA, that works to improve digitalcommunications in developing countries. Cliff has over 20 yearsprofessional experience in computers, networking, multimedia design, andapplications development. He combines this with his long-term interest ininternational development. The eGranary Digital Library is a program ofthe WiderNet Project, and provides an 'Internet in a Box' to theunconnected majority, by storing huge amounts of information on harddrives on internal networks. It contains books, websites, journals, moviesand audio files from hundreds of contributing authors andpublishers who freely contribute to help bridge the digital divide.missenc AT widernet.org

Paul Mwanzilo is the Librarian of the Faculty of Health Sciences Library,Egerton University, Kenya. He holds a diploma in Information and has over20 years in academic library work. mwanzilo AT yahoo.com

Brian Ostrow works with the Office of International Surgery, University ofToronto, Canada. His interests include the Ptolemy Projecthttp://www.ptolemy.ca/ which provides surgeons in the developingworld with online access to the University of Toronto library; and Surgeryin Africa http://www.utoronto.ca/ois/SIA.htm which publishes reviews onthe topic. brian AT bookshelf.ca

Helga Patrikios is an independent consultant based in Newbury, UK. She iscurrently working on the history of leprosy. She recently retired asmedical librarian of the University of Zimbabwe. helgoid AT yahoo.com

Lenny Rhine is University Librarian Emeritus at the University of Florida,USA. His interests include: delivery of health information in developingand transitional countries; electronic health information; Internetresources; and training for identifying, filtering and using Internetresources. rhinel AT ufl.edu

Paget Stanfield is a retired paediatrician with an interest in theavailability of learning materials and textbooks for medical students andpostgraduates in developing countries. He has a long experience in Africa,particularly with the Makerere University, Uganda, and AMREF. Paget iseditor of the textbook, Diseases of Children in the Tropics.welcome.stanfield AT c-pac.net

Abby White is co-founder and coordinator of Daisy's Eye Cancer Fund, anOxford (UK) and Toronto (Canada) based charity that takes a globalapproach to the needs of children affected by retinoblastoma, anaggressive but highy treatable childhood eye cancer, which kills over7,000 youngsters each year. Abby is based in Oxford, UK.http://www.daisyseyecancerfund.org/ abby AT daisyseyecancerfund.org

Dave Woods is emeritus professor in neonatal medicine at the School ofChild and Adolescent Health, University of Cape Town, South Africa. He isChairman of the Perinatal Education Trust and Eduhealthcare, bothnot-for-profit non-government organisations that develop appropriateself-help distance learning material for doctors and nurses who care forpregnant women and their children in under-resourced communities. He has30 years experience as a clinical neonatologist, with particular interestsin perinatal care and training of health professionals. He is currentlydeveloping paper-based continuing learning material in maternal care,newborn care, childhealth, and care of adults and children with HIV/AIDS.He is also participating in the design and development of wind-upappropriate health technology for poor countries. www.pepcourse.co.zapepcourse AT mweb.co.za

How European Consumers Use the Internet for Health Information

In Europe, where strict regulations currently govern the communicationof information about prescription medicines and treatmentalternatives, the primary pharmaceutical marketing focus to date hasbeen directed at the people who write the prescriptions: thephysicians. Now for the first time, Manhattan Research revealsEuropean consumers' attitudes and preferences for finding health andpharmaceutical information with its new study, Cybercitizen(r) HealthEurope.

Which pharmaceutical websites are European consumers visiting forinformation to help make critical healthcare decisions for themselvesand their families? The study reveals the leading health andpharmaceutical websites based on the number of visiting Europeanconsumers, while detailing consumer satisfaction with site content,applications, tools, and features.

Friday, July 27, 2007

Sexual Health SIM project in Second Life

I know very little about Second Life or other Multi User Virtual Environments (MUVEs) - I have enough trouble finding time for real life - but was recently sent an invitation to review information about the new Sexual Health SIM project in Second Life, supported by the University of Plymouth.

Thursday, July 26, 2007

RCN e-health survey

The Royal College of Nursing has today published the results of it's annual e-health survey conducted by Medix. which used an online questionnaire to obtain the attitudes and experiences of 2,600 members towards IT and their perceptions of the new electronic patient record.

* Two thirds of nurses (66%) welcome the introduction of an electronic patient record. This figure is higher (76%) in nurses who have experience of using records in this format.

* 58% of nurses do not believe or do not know that the NHS can deliver an electronic record in the foreseeable future.

* 66% say they have not been consulted about the record's development

* 55% of nurses say they have not received any IT training within working time in the last six months

* And 45% say they share a computer with five or more people while 16% share a machine with more than 20 people.

The perceived effect of the Electronic Patient Record (EPR) on clinical care continues a downward trend with now only 42% of respondents believing it will improve clinical care compared to 70% in 2004.

Sorry the Medical Info and Patient’s Details not for Yellow Pages

Still searching and working on the medical Privacy system . And patients Privacy , may be that developer knows more than i do to lunch that kind of project , and with perfect system to provide a privacy protection and consider the public safety .

I reported the Health Minister at that country , and no response yet , another Individual action taken by another developer , who realize the dangerous satiation of this event … so he cracks the site and dysfunction it….

some people are really excited to help , but take Individual Moves that cause problems may be more than that problem they need to solve…. as an example of an Arabic identity “ so to get excited , and easy to forget the cause !! “ ..

Current Situation :

- The nonspecialist’s moves and people who are not aware of those kind of situations ….. seeing it as good effort , project for humanity ..etc and admire the developer move.

The Developer , Don’t know , Realize , search or even ask before he lunched his project.

..didn’t give the project sometime to study , he is just seeing the problem as making the people helping each other ( Chaos never provides help ) .

He is seeing the usability of the project not the feature of the project , and the Technical issues , and considers the Organs donations ( or Trading ) as some kind of Fantasy … ( even there is a some people already used the site for that ).

The Health Ministry at the Targeted Country shows no response Yet… my be it’ll take some time before they response or take a real action …

Medical standards and Protection of those Medical Standards , for situations like this still amature … but soon or later we need to developed a Medical Standards for e-Medical Info Protection .

-The developers asking me why i made that move against his move in public , well , first your project consider the people life and affect the public safety , so this is not matter of personal suggestion or personal thought , or personal discussion …. it’s Something crosses the red line of all medical standards that’s i should save as a Doctor .. your mistake doesn’t considered as Crime “ even it’s indirect one “ but still considered as Crime ….

-another one at the developer's blog , seeing the patient's data belong to them and they have the right to publicize it and publish it where they want , as example some adds in newspapers , " I need a Kidney , for (......) , any one for donation or selling we buy " , interesting issue , especially when the official desks could never control this public medical adds in the future ..

- a doctor from another Arabic country , working at the Health Ministry , contact me , telling me , "ignoring the project that's could kill it , we don't need people excitement and emotions to convert the serious issues to public adds at news paper , we could be doing th solid ground Historical bureaucracy as you called us , or involve those kind of projects which lunched by people unaware of medical issues . "

Questions :

-Is this an Isolated Situation ? Yes and No.

….quite Yes cause it’s regarding the most common Arabic use and mode of thinking “applicate without spending sometime to study … “

…..No , cause we need to set medical standards for medical info protection , Freedom of Speech never considered as using the Patient’s Data in yellow pages ….

-Medical Data !!? :

Medical Data , Patient’s Details , Public Safety , and Medical Studies Data, is quite sensitive fields , and Unexperienced , people never help as soon they are from the common solid medical background …

some email asking me about the Mafia , and how it could be involved in those kind of projects ?!

Simple answer : unofficial projects , provided from Individual moves , away from the official support and supervision ., will provide open Portal , or Open Market for the Unofficial Organizations or Individuals , may be those could be Map. Or even Doctors ( who are involved in the underground activities ) …

simple point :

Advertising = advertising for any thing , requests , offers …… = Open Market => Money , Money as the most curse for the humanity for ages => will provide the reason/ Motivation , for the people who will used the advantage of the Situation …(what ever who are those people) ,…..

Sunday, July 22, 2007

10 days ago , a Friend sent me this site tabara3.com saying it’s the first Arabic application using Rubyonrails , so i added it to my todo list to see it later when i get some time , thinking of it as an armature work and training project as all other Arabic projects , a week ago this friend send me back

”strange you are a doctor , you should be interested “ ,

“ Interested ! About what exactly? “ ,

“ the site for blood donation “

“WHAT ? “

“Online Blood Donation “ …

here come to the monument , i stopped everything i was doing ( Closed all Browser window , Stop Coding , and close my Favorite Music ) and back to this miracle ( the site ) , Miracle to add this kind of project to become a training armature project !!!!!..

I Opened the site : to get simple interface design , and Fascinating Blood Donation Requests …. from the individuals ( Patients and Patient’s Relatives ) who are seeking for blood or people who are donating ….. some people add they want to donate their blood , ( good effort and Generous of Them !!!)…

But here comes the real example of involving the people who are unaware of Medical privacy , Privacy protection and Public safety in those kind of projects … as example Interesting Requests and submission you’ll get in the requests list :

Feel free to See all the Patient's Data online .with no restrictions or privacy by the patients and patient's relatives themselves

The common Arabic Misuse : The Project became something else

People ( Patient’s Relatives ) asking of Organs ( Kidneys ) and people who can donate it !!!

People saying They want to donate their one of their kidneys … Including Their own Cell phone Numbers and contact details .( My Question is : it’s selling Or donating “ Hard to tell the difference here )

Fascinating , I believe this site for blood donation ( i don’t know How ,but seems some people interested ) AND the hard reality it becomes something about Organs transplantation and Donation On line , ( i don’t wanna to say Trade ).

The Law is the Law and Now They have to Go : (Hot Fuzz –2007 movie , quote ‘ Simon Pegg ‘ ) :

The Medical Law included the Privacy Protection for the Patient safety and for the Patient sake …. here i see this site as example with developer doesn’t realize the Privacy Protection as one of the major items of the Medical Practice and Medical Info these day , surly he doesn’t expect it becomes that Far to be that danger for the public safety …

The Patients :

The Patient’s Relatives, are willing to do anything and crossing the red lines starting with paying Money , for what they believe it’s for the patient sake , and that’s why the official Medical systems made for , to Organize and arrange those kind of operation and events.

Awareness of the Privacy Protection , surely will be considered for the public safety , why : using unofficial systems that’s could include Unofficial people , unofficial methods to get what they want .. ( Imagine may be the Organized Crime )

Patient , Patient’s Relatives : Mostly don’t consider seeing the larger View as the System dose … what if the Patients can Do Official adds in the Newspaper asking for Kidneys , Livers , Hearts ??? I believe that’s The real Definition of “ Chaos “…

4-He provides a tool for Patients welling to do anything include paying for what they need to help them crossing the Official Desks , Helping them to not use the official Channels and Publishing / Publicize they Needs On line , Crossing the Official Channels is the real danger .. helping them in that silly way , doesn't solve the problems but it'll made the problem more complicated ..

5-helping the people they need Money or thinking their body as a tool of trade ( kidneys as example )to Contact with those Disparate patients … ( Open Market )

7-This developer , cross the Official Channels himself , Awareness or Complete Ignorance ( no Much Difference ) but this Kind of Project should be belong to the Official Channels and Under the medical law with restricted medical supervision …

Official Channels :

1-No Response yet .

2-The response should be follow by a Privacy/Public protection Move .

3-Respected and Restricted Law for the Medical project and unofficial Channels .

Conclusion :

Law : No Law Yet for Quite an On line events / projects / individual Moves like this !!!( International or Locals )

Developer Awareness : regrading what happened in this Project and how dangerous it’s for the public safety , seems the developers should read more about the points Considered in medical informatics projects , Privacy protection , and medical laws .

Official Desks /Channels and Control :If Those kind stuff controlled Or Mistreated It’ll Transfer it to an Open Market of Under Ground Medical activities and events .. which it’s Hard to be controlled , so Open Market , Organs Trade , and Underground medical activities Could be Controlled by the Mafia ( Why Not!!! ) so it could become WWW , World Wild Web not World Wide Web .

First global carnival of health informatics

The First global carnival of health informatics was posted on July 22, 2007. This blog carnival brings together recent blog posts on health informatics (including nursing, biomedical, and medical informatics) from around the world - and maybe some posts about issues tangential to health informatics and its areas of activity.

Feel free to take a look at some of the interesting recent posts which have been highlighted & submit your own content for the next carnival which is intended to be posted monthly.

Friday, July 20, 2007

Draft Recommnedation on e-health

The ICT for Health Unit of Directorate-General Information Society andMedia is in the process of drafting a Recommendation which outlines aset of recommended guidelines for good practice on eHealthinteroperability. This draft Recommendation is submitted for informalpublic consultation.The overarching notion is of a European service space in which, andthrough which, European citizens and their designated healthprofessionals can access the necessary health services.The Recommendation is addressed to all the EU Member States, but italso has relevance for the European Economic Area (EEA) countries, andfor the appropriate industries and stakeholder associations that workin the eHealth field.Read more...http://www.ehealthnews.eu/content/view/646/62/

Blogging from Baltimore this week

Peter Murray and Scott Erdley are at SINI2007 this week, the 17th Summer Institute in Nursing Informatics from the University of Maryland Baltimore School of Nursing. The blog can be found at:http://differance-engine.net/SINI2007blog

Today we had what we think is a world first for a health/nursing informatics blog - sending a blog post direct to the blog from mobile phone - specifically iPhone. This is not sent by email, but direct from the web browser interface of the iPhone.

Wednesday, July 11, 2007

Creative Commons licencing in UK public sector

The use of Creative Commons licences allow public sector bodies such as libraries and museums to enable others to use their images and other resources on a not for profit basis.

As Eduserve say "Digital resources produced by publicly funded organisations are a valuable asset to the research and education community. Many people in the sector believe that access to and use of these digital resources could be better and that the wider use of open content licences would help to improve the situation."

Unlike the default “all rights reserved” copyright status, Creative Common’s “some rights reserved” approach enables organisations and individuals to use, share and copy texts, images and other materials easily and legally if they follow certain simple guidelines. The study will investigate how open licences, including those created by Creative Commons (CC), are used by cultural heritage organisations.

I would welcome the potential of these developments and hope that it is an initial example of moves to make the data and resources paid for by taxpayers money more widely available.

Tuesday, July 10, 2007

EMERGE conference

For the last couple of days I’ve been in Manchester/Salford attending the EMERGE conference.

On Monday evening approx 100 individuals from all over the country gathered at the Golden Tulip Hotel, next to Old Trafford football ground, for initial drinks and dinner. Once I’d sorted out the problems with my accommodation booking. I met various colleagues I’d bumped into before and several new ones. Meeting new people was encouraged by an activity after dinner which required people to move tables and speak to people from projects they didn’t know anything about – this and drinks in the bar was useful to find out about the range of people and ideas represented at the conference.

Tuesday morning started with a coach from the hotel to the Lowry Centre where the conference was being held – this was only a few hundred yards by the pedestrian route but a couple of miles by road! The venue was impressive and welcoming.

Delegates were welcomed by George Roberts who is the director of the EMERGE project, who gave an overview of progress so far. He emphasised the importance of the UIDM model in forthcoming bids,and the use of appreciative enquiry in the project progress and evaluation.

He suggested that the various communities within EMERGE – adopt a team member. Josie Fraser then coordinated a community showcase when all the various projects had a couple of minutes to briefly describe their proposals, recruit collaborators and publicise their round tables and other activities for later in the day. The list of these showed the widespread range of activity ranging from improving academic writing through social scaffolding through learning design to Second Life, World of Warcraft and other MUVEs. A couple of the showcase projects which were particularly significant for the Mobile T’s I was representing included:

Salford – multi author blogging for data generation for later use in learning resources

New HEI in Suffolk (to be Uni in a few weeks) using web 2.0 & VLE to support nurses recording their learning (later conversations about podcasting skills videos)

After the initial showcase a welcome cup of coffee gave opportunities for further networking, and to follow up some of the things mentioned so far.

After coffee 7 simultaneous “round tables!” were available (along with UIDM workshops & an unconference, which I didn’t manage to get to). The first I attended was with the Bradford team discussing a range of aspects of the use of audio to support learning. A lot of this work related to the ALPS project & it was suggested the Leeds Met e admin project may also be relevant.There was lots of discussion about thow the technologies can be used to change the top down teacher led model of education to one which empowers students and recognises that they are experts & how their self assessment and reflection can be enabled. There seemed to be lots of good opportunities for collaboration between a range of different communities with this project.

After a good lunch and more networking, I attended another round table session led by the Bloomsbury consortium (SOAS, RVC, Institute of Education & others). About Appropriate and Practical Technology (APT) which aims to look at real world issues around assessing needs, and selecting appropriate technologies (including paper & pen) for particular learning needs (links to Transliteracy – a new term to me which seemed to be appropriate). This table seemed to the people who were grounded in the real world rather than those who were off playing with Second Life and similar wizzy technologies. Again their seemed to be good opportunities for collaboration & they proposed to gather examples of good (and bad) practice from different institutions and disciplines to prevent re-inventing the wheel and share practical real world solutions to learning needs.

The day closed with a short plenary about the evaluation of the project by Rhonda and some closing remarks by George who as the project director tried to give a helicopter view of the disparate work going on & suggesting the deadline for bid submissions would be extended to October which would affect the timing of the (possibly virtual) town meeting and a project development (not bid writing) day and a platform user group day.

Medical/Scientific Softwares at Linux repositories

Linux as Free Open Source Operating System , provides new variations in options and choices of the daily common use software with free alternatives ones , such as Open Office (writer , spreadsheet , Presentation , drawing , base ) as an Alternative for Ms.Office ( word , excel , power point ,and access ) ……..But The real disadvantage of using Linux was : ( for normal users ) is how to install software!! , there was no default standard install system for the softwares , each software with special Instruction file to configure and install it , sometimes the instructions need an advanced user to understand and do it , and some software need an Extra Library to be installed …

These day there is many Solutions for Installing software on linux , such as Autopackage* and Online Packages through Package Managers , and Complete Guides to install Software on many linuxDistro , even Windows Softwares through Windows Emulator as Wine …

Easy to install the software you need through the Package Manager , which is the common feature of known and usable Linux Operating systems …Package Manager as Synaptic Package Manager simple and easy to use , Search or Browse For the software you seek , then select it and click apply , in mins/secs ( according to your internet connection and the Software/s You choose ) you’ll be ready to use this software …

Using the Debian Based Linux ( eLive , LinuxMint , DreamLinux , Ubuntu ) , i enjoyed the amount of software i installed and tried from the Debian repositories , but something i missed , The Medical Software like EMRs , Image Analysis tools ,…….etcthere is a Scientific and Mathematics categories at Debian Packages -link- , and with some Biological softwares , but huge lack of Medical software …..

in the first lost archive of goomedic.com i wrote about debian-med and some medical softwares which run on linux which suggest some good progress in Medical-Linux software and usability , but using the Linux repositories makes me wonder why in linux world we always have defect in medical software and attention to spread and publish these software .?!!!!

Conclusion :regrading to the search and use of Linux we do and the suffring for lack of alternative Free Open Source medical packages on the common linux repositories , seems it’s not lack of Production as it’s Lack of use and decrease in number of the Users …

The Request :1-adding Multi Packages format for the different Linux Distros at the official software site2-packaging this software to the linux repositories ….3-Using Autopackage4-adding the software in any medical software directories and sourceforge.net

Monday, July 02, 2007

Medical Informatics Developers and Medical Experience..

Back in Cairo Months ago , I tested and tried some EMRs , HMRs ...some are developed by Freelancers and the Others Developed by programmers from IT Universities , the first look at those software which supposed to handle the Medical Records and provide us as ( Doctors , Researchers and Medical Related ) with needed Medical Records , Data ... I find most of the software are missing a lot of urgent Needs which save us time, in search, and record .... Backup Feature sometimes was good, but otherwise was a mess ..... a lot of the software users didn't get training for all the software they were using, and how to handle the Data Flow, and Input/output options ...... but some of them already got some training , but the Training was for the common daily use features not for Hidden features as well as Software Configuration ...

Some of those software was Complete Mess in Interface design ( Lack of Features or Too Much Features added ) ...... sometimes the Users (Doctor , Nurse , Researcher ... ) feel Confused , Too Much options , Lack of Customization , heavy Interface full of Unnecessary/Unusable stuff ......

Of course , You might say that the cause is the lack of training they got, and the User could be familiar with Interface ( any interface ), but it seems to me it's about Customizations of the Interface for the Users and the needs ...I believe standards of software's Interfaces should be applicate in medical software as well ,

... after some discussion with Dr. Moaaz months ago I have to take 2 looks at those types of software, first look as a User Doctor , second look as a Developer, and trying to understand the Importance/Use of Medical Data and Data Flow as a Researcher .. That's why I wrote 2 articles about that : " Features of Successful EMR software " and " Standards for Evaluation of Medical Records software " ...i'll try to add them soon.

conclusion

-Interface :Developer's opinion and Doctor's Use : 2 types of interfaces I noticed and they were too radical in my developer's opinion , and too confusing in doctor's opinion (user) : 1-Too Much Features, Gathering in the same interface, with the daily needed and uncommonly needed features. 2-Small simple Interface with the Basic Need of the software ... the other features are listed in the program menu panel

Extensive Use of Forms/Frames : using of forms was extensive ( sometimes ), sometimes the need for small info or doing small action getting into 3 or 4 forms. Work in it as it is : Interface Customization : never got that interest by most of the developers, that would be helpful for some users, to collect and arrange the daily needed features in the interface.(Forbidden Features ) : I see but i can't get / I click but it doesn't work , sorry this feature is only for the admin : Sometimes I get the meaning that I am neglected as a normal user, I can't use 20 to 30% of features I see in the interface as I am just a User ... so why the need for these forbidden features in the user interface ?!! ( Q for the developers ).

When I was in self-study mode studying the Software Interface Design : I recognized the simple common Interface with commonly Traditional Menus ( Menu bar , Tabs , Buttons Menu , Features Menu ) was easy to get Familiar with and dealing with the software features as It's easy to find what you are looking for .... regarding the Freelances EMRs with the unique Interface designs, which definitely need training, help, tutorials to help the user to be familiar with the software ...

-Search ( for Patients , events ) :Basic Search : This Search type aims at getting the Data of the Targeted Data by name ( No Spell Checking and correction ) .

Expanded Search and Advanced Search Features were really disappointing ... lack of Search Features might be caused by the developer focus on the Data Input and about more than finding these data or specific data ...

Search Parameters and Search Tags : from over 40 software : I get only 2 softwares which focus on the Usability of specific data and using it as Tags or anchors for search .... and using this "Tags" to classify and arrange the Data ...

The developer should Differentiate Between Statistical Search and normal User Daily Search .... and make special user Privilege for the Statistical Search , which I never notice even for the software which consider the Statistical Search .

-Statistics :

Statistical Data and Data Analysis : Huge amounts of Medical Data and Medical Related Data are so important in Medical Statistics, and that reminds me of one of my teacher's opinion about an EMR software " Why I should Extract ( Export ) the Data then Analyze it in other Program , to Get My Statistics ? "and my Question is : the user of an EMRs software mostly doesn't need the Statistical Data and Data Analysis , but some people do , so Why the developers didn't use User privileges to get That Statistical and Data Analysis Operations working , under super user Permission ?!!

some other thinking : Exporting the Data in Spreadsheets files ( Comma Separated Value (.csv) , Microsoft Excel (.xls) files and OpenDocument Spreadsheet (.ods) )... then using it in another softwares.

Medical Statistics and Medical Data Analysis are very Important for Medical Researchers as well as Pharmaceutical Companies.

-Security :Security for Patient Info is Necessary, to Protect the Patient Details and provide Privacy for Medical Data under the general law of medical Profession ...Most of the software I've seen are completely lack of security , especially when it comes to my geeks side , sometimes under the basic Techniques I find it easy to extract the Non-Encrypted Data ... but that's was in some basic EMRs.some more basic ones already got no access password and sometimes without any user system at all..

of course there are Great ones taking care of this Security matters ... and Data Encryption , but The Great Extra Feature I've ever seen is Encryption of the Backuped Data ...

-Users levels - Users privileges :at Forbidden Features ..in Interface Section : I recognized many of EMRs Systems never care about User levels and Privilege and deal with the system as one Block , sometimes for one level of users ( even there is Multiple users level ) , and single one Interface even there is users level and many privileges , ( Why there is unused - inactive features ( Forbidden features ) for the normal daily users ? as (Backup ,Configuration , Encryption , Security ..etc )

User supposed to work with this EMR ? who ? and what are their privileges?? The Daily User should not get an access to Statistical Data or Statistical Search ..

-Software Compatibilities , Operating System , and Other Software Compatibilities and Dependencies : In Pre-Alpha (and/or Pre-Beta) Testing the Developer/s should get the first error and Compatibility debugging reports , letting the User get the first hits of errors never was good idea ...

-Backup (DB Backup and Configuration Backup) :Using Backup aimed to save the Medical Records Data from being lost ( Human Error , Hardware error , Software error , Operating System Crash ) .Two types of DB Backup system we got so far :1- Same Species ( Same software ) special backup system dedicated to this special EMR Using special Encrypted Files , can be used only by this software.2- International Backup , Using Spreadsheets files ( Comma Separated Value (.csv) , Microsoft Excel (.xls) files and OpenDocument Spreadsheet (.ods) )...International File Backup System : can be imported in Statistical Analysis systems .....

-Communication :Communication is a major Needed especially in Hospitals and Research Centers , definitely when this EMR is working on Network mode for Multiusers and for many related departments (as ex. Surgery , Radiology ) , Communication Between the Users should also consider the Data Transfer Mode ....

-Training :Lack of Training among all these EMRs was the common disadvantage , I notice , Confused User has to deal with the Interface ( simple or Complex ) with amount of Features ( low , or Too Much ) as well as configuration / re-configuration of the system or Backup of his Data ....Documents , Help files , FAQs , sometimes were great , but the developers could save time if they considered the Training could save the User Time .

-Development and Experience :As result of lack in medical Experience most of the developers ,produce insufficient software with , sometimes with lack of features , or missing the points of our daily medical use ...The aim of this topic is to provide the developers /project's Directors and sometimes at the hospital to know the medical need and experience the medical reality themselves to help us gaining time not loosing it ..

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Eclectic news and views on health informatics and elearning, by Rod Ward & colleagues. UK bias but worldwide coverage.
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